J Korean Assoc Oral Maxillofac Surg.  2023 Aug;49(4):171-183. 10.5125/jkaoms.2023.49.4.171.

Mapping out the surgical anatomy of the lingual nerve: a systematic review and meta-analysis

• Lin SXY
• Sim PR
• Lai WMC
• Lu JX
• Chew JRJ
• Wong RCW

• KMID: 2545582
• DOI: http://doi.org/10.5125/jkaoms.2023.49.4.171

Abstract

Objectives
Understanding the lingual nerve’s precise location is crucial to prevent iatrogenic injury. This systematic review seeks to determine the lingual nerve’s most probable topographical location in the posterior mandible.
Materials and Methods
Two electronic databases were searched, identifying studies reporting the lingual nerve’s position in the posterior mandible. Anatomical data in the vertical and horizontal dimensions at the retromolar and molar regions were collected for meta-analyses.
Results
Of the 2,700 unique records identified, 18 studies were included in this review. In the vertical plane, 8.8% (95% confidence interval [CI], 1.0%-21.7%) and 6.3% (95% CI, 1.9%-12.5%) of the lingual nerves coursed above the alveolar crest at the retromolar and third molar regions. The mean vertical distance between the nerve and the alveolar crest ranged from 12.10 to 4.32 mm at the first to third molar regions. In the horizontal plane, 19.9% (95% CI, 0.0%-62.7%) and 35.2% (95% CI, 13.0%-61.1%) of the lingual nerves were in contact with the lingual plate at the retromolar and third molar regions.
Conclusion
This systematic review mapped out the anatomical location of the lingual nerve in the posterior mandible, highlighting regions that warrant additional caution during surgeries to avoid iatrogenic lingual nerve injuries.

Keyword

Alveolar process; Anatomy; Lingual nerve injuries; Third molar; Meta-analysis

Figure

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  Fig. 1 Prisma flow chart illustrating the selection process of the included studies and the number of excluded studies at each stage.

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  Fig. 2 Forest plots of the vertical position of the lingual nerve. A. Prevalence of the lingual nerve coursing above the alveolar crest at the retromolar and third molar regions. B. Vertical distance between the lingual nerve and the alveolar crest.

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  Fig. 3 Forest plots of the horizontal position of the lingual nerve. A. Prevalence of the lingual nerve contacting the lingual plate at the retromolar and third molar regions. B. Horizontal distance between the lingual nerve and the lingual plate.

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  Fig. 4 Risk of bias (ROB) evaluated using the AQUA (Anatomical Quality Assessment) ROB tool, reported as the percentage per criterion.

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  Fig. 5 Illustration of the lingual nerve’s course in relation to the alveolar crest at the retromolar and molar regions of the lingual surface of the mandible. Majority of the nerves is located inferior to the alveolar crest during its course. The red line (①) represents the lingual nerve’s mean vertical location with reference to the alveolar crest, while the red zone represents the 95% confidence intervals. The distance between this zone and the alveolar crest is represented by the green arrows. This distance is the safety margin to the possible location of the lingual nerve at each landmark. A minority of the lingual nerves would course above the alveolar crest at the retromolar (8.8%) and a partially erupted third molar (6.3%) regions as represented by the orange line (②).

Reference

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